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CH36 p3 > ch 36 p3 > Flashcards

ch 36 p3 Flashcards

1
Q 
Which of the following small volume jet nebulizer design features affect its performance?
A.  position
B.  Residual volume
C.  Baffles
D.  Reservoirs
A

All items

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2
Q 
All of the following are categories of nebulizers accept:
A.  pneumatic jet nebulizers
B.  USNs
C.  VM nebulizers
D.  DMI
A

D.

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3
Q 
Small volume jet nebulizers are used to commonly disperse what volume of medications?
A.  20 to 50 mg
B.  5 to 20 ml
C.  20 to 50 ml
D.  5 to 20 mg
A

B. SVN most commonly used for medical aerosol therapy hold 5 to 20 ml of medication

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4
Q 
How much medication can a large volume jet nebulizer hold?
A.  500 ml
B.  100 Ml
C.  200 Ml
D.  150 Ml
A

C. 200 ml

Large volume jet nebulizers can hold up to 200 ml of medication

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5
Q 
All of the following drug formulation characteristics affect the performance of small volume jet nebulizers accept:
A.  homogeneity
B.  Surface tension
C.  Viscosity
D.  Potency
A

D. Potency of drug does not affect performance of SVN

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6
Q 
What is the average amount of dead volume in a small volume jet nebulizer after the device runs dry?
A.  0.1 ml
B.  0.5 to 2.2 ml
C.  2.0 to 4.0 ml
D.  less than 0.1 ml
A

B. the residual volume of a 3 ml dose varies from as little as 0.5 ml to more than 2.2 ml, which can be more than 2/3 of the total dose

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7
Q

During aerosol drug delivery using a SVN set at 8 L/min input flow, a patient asks that the head of the bed be lowered to semi fowler position, immediately after doing so, you observe a significant drop in SVN output despite the fact that there is at least 3 ml of solution left in reservoir, what would correct the problem?
A. add 1 to 2 ml more diluent to the reservoir
B. increase the nebulizer flow to 10 to 12 L/min
C. reposition the patient so that the SVN is more upright
D. Decrease the nebulizer input flow to 3 to 4 L/min

A

C. reposition the patient so that the SVN is more upright

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8
Q

The higher the flow of gas generated in a nebulizer, the ______ size of particle size.
A. Higher
B. Smaller

A

B. Smaller

Droplet size and nebulization time are inversely proportional to gas flow through the jet

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9
Q 
What is the name for the dead volume of medication remaining after the device stops generating aerosol?
A.  Residual drug volume
B.  Viscosity
C.  Liquid in reservoir
D.  Drug loss
A

A. Residual drug volume

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10
Q 
You increase the fill volume from 2 to 4 ml in a SVN being used to administer a bronchodilator agent with an aerosol.  What effect will this have on the amount of drug delivered?
A.  No effect
B.  Increase
C.  Decrease
D.  More waste
A

B. Increase

Increasing the fill volume allows a greater proportion of active medication to be nebulized

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11
Q 
What happens as the pressure or flow delivered through a small volume jet nebulizer gets higher?
A.  Treatment time becomes shorter
B.  Particle size becomes smaller
C.  Aerosol output becomes greater
D.  All of the above
A

D. aLL
The higher the pressure or flow, the smaller is the particle size, the greater is the output, and the shorter is the treatment time

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12
Q 
Which of the following is the effect of aerosol particles entrained into a warm and fully saturated gas stream?
A.  No effect
B.  Increase in size
C.  Decrease in size
D.  Increase in number
A

B. Increase in size

Aerosol particles entrained into a warm and full saturated gas stream increase in size

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13
Q 
What amount of medicine is wasted when using a continuous dose SVN?
A.  50%
B.  60%
C.  40%
D.  20%
A

B: 60%

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14
Q 
What percentage of deposition is measured with the use of SVN?
A.  50
B.  10%
C.  15%
D.  45%
A

B. 10%

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15
Q 
What can conserve aerosolized medications with a SVN?
A.  Baffle
B.  Reservoir
C.  Nothing, you must move to LVN
D.  one way valve
A

B. Reservoir

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16
Q

Which of the following is false about the optimal technique for using a small volume jet nebulizer?
A. SVNS are less technique and device dependent
B. Slow inspiration improves SVN aerosol deposition
C. Deep breathing or breath holding improves SVN deposition
D. Use of a mouth piece or mask provides similar results

A

C. Use of an SVN is less technique and device dependent than use of a pressurized metered dose inhaler or dry powder inhaler delivery system. Slow inspiratory flow does optimize SVN aerosol deposition. Deep breathing & breath holding during SVN do little to enhance deposition. If patient is mouth breathing there is little difference in clinical response between therapy given by mouthpiece or mask

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17
Q 
Normally, when using a 50 psi flowmeter to drive a small volume jet nebulizer, to what should you set the flow?
A.  2 to 4 L/min
B.  4 to 6 L/min
C.  6 to 10 L/min
D.  8 to 10 L/min
A

C. 6 to 10 L/min

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18
Q

To decrease the volume of dead space of a small volume jet nebulizer during drug administration what should you do?
A. Decrease nebulizer flow
B. Turn the nebulizer upside down
C. Continue treatment until nebulizer begins to sputter
D. Increase the nebulizer flow

A

C. Continue treatment until nebulizer begins to sputter

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19
Q

To minimize a patients infection risk between drug treatments with a small volume jet nebulizer what should you do?
A. rinse the svn with sterile water, air dry
B. Carefully repackage the SVN in its wet state
C. Rinse the SVN with tap water, run until dry
D. Throw out the SVN after every treatment

A

A. The CDC recommends they be cleaned and disinfected with sterile water and air dried between uses

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20
Q

A patient with an acute exacerbation of asthma is not responding to the standard dose and frequency of an aerosolized bronchodilator and is now receiving SVN therapy every 30 min. Which of the following would you recommend to the patients physician?
A. Discontinue the aerosolized bronchodilator
B. Increase the frequency of SVN to every 10 min
C. Consider continuous nebulization of the drug
D. Add more diluent to the SVN to extend time
C.

A

C. An alternative approach is to provide continuous nebulization with specialized large volume nebulizer

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21
Q 
What is the major problem with using large volume nebulizers for continuous aerosol drug therapy?
A.  decreased pulmonary deposition
B.  drug reconcentration and toxicity
C.  Frequent interruption of therapy
D.  Greater waste of drug
A

B. A potential problem with continuous bronchodilator therapy is drug concentration increase

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22
Q

A physician ordered the antiviral agent ribavirin (Virazole) to be administered by aerosol to an infant with bronchiolitis. Which of the following devices would you recommend in this situation?
A. Hydrodynamic (babbington) nebulizer
B. Small particle aerosol generator (SPAG)
C. Ultrasonic (piezoelectric) nebulizer
D. Large volume heated nebulizer

A

B. SPAG small particle aersol generator

Was developed by ICN pharmaceuticals specifically for the administration of ribavirin to infants with respiratory syncytial virus infection

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23
Q

The small particle aerosol generator (SPAG) produces a small monodispersed aerosol through wich of the following?
A. Aerosol impaction by sequential baffling
B. Particle evaporation in a glass drying chamber
C. Use of an inert liquefied gas propellant
D. Aerosol generation using vibrational energy

A

B. Particle evaporation in a glass drying chamber

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24
Q 
WHen using a small particle aerosol generator to administer ribavirin to an infant which pair of flow settings would be correct?
Nebulizer       Drying Chamber
A.  8 L/min        8 L/min
B.  5 L/min         5 L/min
C.  8 L/min        4 L/min
D.  4 L/min        8 L/min
A

A. Nebulizer flow should be maintained at approximately 7 L/min with total flow from both flowmeters no lower than 15 L/min

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25
Q

What serious problems are associated with the delivery of ribavirin using small particle aerosol generators?
A. Caregiver exposure to the drug aerosol
B. Drug reconcentration in the drying chamber
C. Drug precipitation in ventilator circuits?
D. All of the above

A

A & C

Drug precipitation can jam breathing valves or occlude ventilator circuits

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26
Q

The problem of ribavirin aerosol precipitation causing malfunction of ventilator circuits can be overcome by which of the following?
A. Placing a one way valve between the small particle aerosol generator (SPAG) and the circuit
B. Placing a HEPA filter proximal to exhalation valve
C. Decreasing the SPAGs total flow to below 10 L/min

A

A & B
The problem can be overcome by placing a one way valve between the SPAG and the circuit & filtering out the excess particles before they reach exhalation valve, changing filters frequently

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27
Q

Which of the following are true about a solution that is being aerosolized by an ultrasonic nebulizer?
A. The solute concentration decreses
B. The temperature of the solution increases
C. The solute concentration increases
D. The temperature of the solution decreases

A

B & C

As the temperature increases the drug concentration increases as does the likelihood of undesired side effects

28
Q

Which of the following makes small volume ultrasonic drug delivery systems different from their large counterparts?
A. They do not use a couplant compartment
B. Drugs are placed directly on the transducer
C. Battery power is available on some units
D. Patient flow, not a blower, carries the aerosol

A

All of the above
Unlike large units, some of these systems do not use a couplant compartment. the medication is placed directly into the manifold on top of the transducer. These devices have no blower, power source can be battery operated

29
Q 
Advantages of small volume ultrasonic nebulizers for drug delivery include all of the following except?
A.  greater respirable drug mass
B.  less dead space and waster
C.  increased mobility
D.  decreased cost
A

D. High purchase cost and poor reliability

30
Q 
What is the average mean mass aerodynamic MMAD generated by the vibrating mesh nebulizers?
A.  1 to 2 um
B.  2 to 3 um
C.  3 to 4 um
D.  5 to 6 um
A

B. 2 to 3 um

31
Q 
In selecting the appropriate aerosol drug delivery device for a given patient, what must you consider?
A.  Available drug formulation
B.  Desired site of deposition
C.  Patients characteristics
D.  Patients preference
A

All of the answers:
In selecting the appropriate aerosol delivery device for a given patient the following must be considered: 1 available drug formulation, the desired site of deposition, the patients characteristics; ability to properly use device, and the patients preference

32
Q 
For maintenance administration of bronchodilators to an adult patient with adequate inspiratory flow, which of the following aerosol drug delivery devices would you recommend?
A.  pMDI
B.  Small volume jet nebulizer
C.  dry powder inhaler
D.  pMDI and holding chamber
A

C & D
For administration of maintenance therapy bronchodilators and anti-inflammatory agents to adults, a pMDI with a valved holding chamber is the most convenient, versatile, and cost effective approach. Dry powder inhalers are gaining popularity as an equivalent to pMDI for maintenance therapy with available drugs for patients capable of generating adequate inspiratory flow

33
Q 
Which of the following aerosol drug delivery systems would you recommend against using with a toddler or small child?
A.  metered dose inhaler
B.  small volume jet nebulizer
C.  dry powder inhaler
D.  MDI, holding chamber & mask
A

A. metered dose inhaler

C. DPI

34
Q 
What delivery system can be used on infants?
A.  SVN
B.  MDI
C.  DPI
D.  Valved chamber with mask
A

A & D

35
Q 
Advantages of the DPI include all of the following except:
A.  easily delivered in high doses
B.  Less patient coordination required
C.  Breath activated
D.  Breath hold not required
A

A. easily delivered in high doses

36
Q 
All are disadvantages of the SVN except:
A.  Expensive
B.  Wasteful
C.  Drug preparation required
D.  Long treatment times
A

A. expensive

SVN are inexpensive

37
Q 
On average, what percentage of an aerosol drug delivery device output actually deposits in the lungs?
A.  less than 10%
B.  10 %
C.  20%
D.  30%
A

B. 10%

38
Q 
Factors associated with reduced pulmonary deposition of aerosolized drugs include all of the following except:
A.  mechanical ventilation
B.  artificial airways
C.  poor patient technique
D.  mouth breathing
A

D. mouth breathing

39
Q

Possible complications associated with selection of an aerosol drug delivery device include all of the following except?
A. underdosing or overdosing because of improper technique
B. overhydration or fluid imbalance
C. adverse effects on the specific drug agent
D. environmental contamination or caregiver exposure

A

B. overhydration or fluid imbalance do not contribute

40
Q

A semiconscious patient with inadequate spontaneous ventilation requires aerosol drug administration. Which of the following approaches would you recommend?
A. Large volume continuous nebulizer
B. SVN
C. SVN with delivery by intermittent positive pressure breathing
D. metered dose inhaler and holding chamber

A

C. SVN with delivery by intermittent positive pressure

41
Q

To assess the effectiveness of a particular aerosol delivery device selection, what would you evaluate?
A. patients technique in using the device
B. Patients response to and compliance with procedure
C. objective measurements of improvement such as peak flow
D. all of the above

A

D. all of the above

42
Q

Which of the following would you recommend as initial therapy for a patient admitted to the ER with acute airway obstruction (wheezing, cough, dyspnea, peak expiratory flow less than 60% predicted)?
A. assess dose response of metered dose inhaler albuterol up to 12 puffs
B. Provide up to 3 small volume jet nebulizer treatments with albuterol every 20 minutes
C. Immediately begin continuous albuterol therapy at 15 mg/hr
D. Answers a, b, c
E. A or B
F. A & C

A

A or B

43
Q

Indications for assessment of patients response to bronchodilator therapy include all of the following except?
A. confirm whether the therapy works as intended
B. individualize dose, frequency, or type of medication
C. help follow the patients status during long term therapy
D. quantify the degree of bronchial hyperresponsiveness

A

D. quantify the degree of bronchial hyperresponsiveness

44
Q

Appropriate documentation when conducting point of care assessment of a patients response to bronchodilator therapy includes all of the following except:
A. medication type, dose, and time received
B. vital signs, breath sounds, pulmonary function test measures
C. patients progress and ability to self assess symptoms
D. blood levels of the bronchodilator agent

A

D. blood levels of bronchodilator agent

45
Q

Which of the following is false about the use of the peak expiratory flow rate (PEFR) in assessing a patients response to bronchodilator therapy?
A. PEFR and lab spirometry forced vital capacity values may be poorly correlated
B. PEFR is the standard for determining bronchodilator response
C. Some peak flow meters are more accurate and reliable then others
D. The peak flow mesure is effort and volume dependent

A

B. PEFR is not the standard for determining bronchodilator response

46
Q

What is the conventional standard for determining bronchodilator response?

A

Spirometry

47
Q

In addition to bedside pulmonary function test measures, what other components of patient assessment are useful in evaluating bronchodilator therapy?
A. patient interview and observation
B. measurement of vital signs
C. Chest auscultation
D. arterial blood gas analysis and oximetry

A

All items are useful

48
Q 
When assessing a patients response to bronchodilator therapy you notice a decrease in wheezing accompanied by an overall decrease in the intensity of breath sounds.  Which of the following is most likely?
A.  Increasing airway obstruction
B.  improving ventilation/perfusion rate
C.  decreasing airway obstruction
D.  deteriorating oxygenation
A

A. increasing airway obstruction

49
Q 
When assessing a patients response to bronchodilator therapy you notice a decrease in wheezing accompanied by an overall increase in the intensity of breath sounds.  Which of the following is most likely?
A.  increasing airway obstruction
B.  improving
C.  decreasing airway obstruction
D.  deteriorating oxygenation
A

B. improvement

improvement is indicated when wheezing decreases and the overall intensity of breath sounds increases

50
Q

Which of the following best describes proper dose response assessment of a MDI bronchodilator?
A. GIve 4 puffs one after the other, wait 1 minute, repeat up to 16 puffs. The best dose is the highest dose given without side effects
B. Give 4 puffs spaced 1 to 2 minutes apart; repeat up to 12 puffs with continued improvement. The best dose provides maximum subjective relief and the highest peak expiratory flow rate without side effects
C. Give 12 puffs 1 minute apart, repeat every 20 minutes until maximum relief of symptoms is achieved without side effects
D. Give 2 puffs 1 to 2 minutes apart; repeat up to 6 puffs with continued improvement.

A

B. A simple albuterol dose response titration involves giving an initial 4 puffs (90 g/puff) at 1 minute intervals through a pressurized MDI with holding chamber. Want to achieve the highest PEFR

51
Q

In a dose response assessment of a patients response to a metered dose inhaler bronchodilateor, when would you stop increasing the dose?
A. when the peak expiratory flow rate improves

A

A. when peak expiratory flow rate improves to

52
Q

An asthmatic patient in severe distress with wheezing and dyspnea is admitted to the er and started on albuterol via SVN. Which of the following approaches would you recommend to assess therapy?
A. perform arterial blood gas analysis
B. continuously monitor the SpO2
C. Assess breath sounds and vital signs before and after treatment
D. Measure peak expiratory flow rate or forced expiratory volume in 1 second before and after each treatment

A

All of the above

53
Q

An asthmatic patient in severe distress with wheezing and dyspnea is admitted to the ER. After conducting a full assessment and obtaining a pretreatment baseline, you start the patient on albuterol with a small volume jet nebulizer. YOu should continue treatment up until what point?
A. the patients symptoms are relieved, or the peak expiratory flow rate/forced expiratory volume in 1 sec exceeds 70% of personal best
B. the patients wheezing disappears, and the intensity of breath sounds decreses
C. the patients symptoms are relieved or the pefr/fevi returns to the predicted normal
D. the patients SpO2 is above 90%, and the pefr/fevi returns to predicted normal

A

A.

54
Q 
After initially conducting a pre and post bronchodilator assessment on a stable asthmatic patient admitted to the hospital, how often would you recommend reasssment of peak expiratory flow rate/forced expiratory volume in 1 sec?
A.  with each treatment
B.  twice daily
C.  once per day
D.  every other day
A

B. Twice daily

55
Q

What schedule of peak expiratory flow rate assessment would you recommend for a home care asthmatic patient?
A. 1 to 2 times daily
B. once per day (on rising or bedtime)
C. 3 to 4 times daily
D. 1 to 2 times daily (at noon and around bedtime)

A

C. 3 to 4 times daily, on rising, noon, 4 to 7pm, bedtime

56
Q

For a hospitalized patient who will require ongoing maintenance bronchodilator therapy after discharge, what should your end goal be?
A. complete relief of all patient symptoms
B. normal airflow and cessation of therapy
C. effective self administration of the drug
D. Peak expiratory flow rate that exceeds 70% of personal best

A

C. for patients who need ongoing maintenance therapy after acute phase of illness, the goal should be effective self administration

57
Q

Which of the following factors is most crucial in developing an effective program of aerosol drug self administration in an adult patient requiring maintenance bronchodilator therapy?
A. proper device selection
B. well written brochures
C. Reliable peak expiratory flow rate meter
D. Good patient education

A

D. effective patient education

58
Q

Which of the following patient skills are necessary to ensure effectiveness of drug administration via the aerosol route?
A. ability to keep track of dosing requirements
B. understanding of the methods and goals of therapy
C. Ability to recognize undesirable effects
D. All of the above

A

D. all of the above

59
Q 
What is the recommended dose for continuous bronchodilator therapy?
A.  0.5 mg/hr
B.  5.0 mg/hr
C.  15.0 mg/hr
D.  50.0 mg/hr
A

C. 15.0 mg/hr

60
Q 
indications for an adverse drug response include:
A.  worsening tachycardia
B.  Vomiting
C.  Palpations
D.  cyanosis
A

A, B, C

61
Q

To provide an extra margin of safety during continuous bronchodilator therapy which of the following would you recommend be monitored?
A. eosinophil count
B. serum potassium levels
C. electrocardiogram

A

B & C
Some clinicians recommend that patients undergo continuous electrocardiographic monitoring and measurement of serum potassium level every 4 hrs

62
Q 
On average, what is the range of the actual pulmonary deposition of small volume jet nebulizer aerolized drugs in intubated patients receiving mechanical ventilation?
A.  1.5 to 3
B.  3.5 to 6
C.  6.5 to 9
D.  9.5 to 15
A

A. 1.5 to 3 %

63
Q 
When using a chamber style adapter with a metered dose inhaler to deliver a bronchodilator to a patient receiving mechanical ventilation, with what would you coordinate MDI firing?
A.  beginning of inspiration
B.  beginning of exhalation
C.  end of inspiration
D.  middle of inspiration
A

A. beginning of inspiration

64
Q 
Which of the following drugs present the greatest exposure risks for health care workers?
A.  albuterol
B.  pentamiding
C.  ribavirin
D.  acetylcysteine
A

B & C

Pentamadine & Ribavarin

65
Q

What can the RT do to determine the best dose for bronchodilator therapy for patients with moderate obstructions?
A. dose response titration, 4 puffs at 1 minute intervals
B. 12 puffs to clear obstruction
C. 6 puffs every 2 minutes
D. 4 puffs every 2 minutes

A

A. dose response titration

CH36 p3 (1 decks)

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